Statement of Informed Consent
Review the Statement of Informed Consent and let us know if you have any questions. We cannot treat you if you do not sign this form. You will be asked to sign this form when you arrive for your appointment.
This notice describes how psychological and medical information about you may be used and disclosed, and how you can get access to this information. You will be asked to acknowledge that you have received our notice of privacy. You may print out our HIPAA notice and keep a copy for your records.
Release of Information
If you would like information about your treatment to be released to another party you will need to complete and sign a Release of Information Form. There are a few circumstances in which we may be bound by law to release information without your written consent. These circumstances will be discussed with you at your scheduled appointment.
Please note, in most cases, we are prohibited by law from disclosing raw psychological and neuropsychological test data and test materials to anyone other than a licensed psychologist qualified to interpret such data.
Electronic Communication Policy
Statement of Financial Responsibility
Get In Touch:
If you have any questions, would like to refer a patient, or to set up an appointment please call or send us an email.
Phone number: 541-306-6456
Fax number: 541-647-1580